Does Anybody Here Perform Breast REMOVAL Surgery (FTM)?
Doctor Answers 11
FTM "top surgery" for chest masculinization
For example, inverted-T, anchor, or Wise-pattern mastectomies are not only unnecessary (even for large or pendulous breasts), they are decidedly feminine incision choices, especially when better choices exist to create a much more masculine chest.
Nipple design and placement is another common area of poor choice, as failure to recognize that the masculine nipple/areola complex is small (21-22mm in diameter), with a small, virtually non-protruding papilla, and is low and lateral in position (not higher and central, like female breasts). Take a look at any male model with his shirt off to confirm these "normal" anatomic landmarks, and then look at some of the photographic results some surgeons post. Scary.
Then there are the mastectomy flaps themselves, often thinner than the surrounding subcutaneous fatty layer, giving a dented, scooped, or shark-bite appearance to the chest. This is not necessary, and finding the exact breast gland-fatty layer interface is a surgical art unto itself, and critical to proper flap thickness, as well as complete (99+%) breast tissue removal. Leaving 10-20% of the female glandular breast tissue achieves what goal?
Too many patients request "keyhole" mastectomies (and too many improperly-motivated surgeons are eager to capitalize on these requests), which are suitable only for transmen with the smallest breasts. Otherwise, wrinkled, Shar-pei like skin remains, and is disfiguring as well are requiring more surgery to correct this deformity. Another related mistake is to try to maintain nipple/areola complexes on vascularized pedicles, which not only creates too-large areolas, too-protruding nipples, and malpositioned results, but also fails to retain sensation, which is another common "sales pitch." If the breast tissue is completely removed (which it should be), the sensory nerves to the nipples will be removed as well, and has nothing to do with "saving sensation" other than incomplete breast tissue removal. Free nipple grafts are necessary for optimum size, shape, configuration, and position, and will by necessity be numb. But with results that are masculine, not pseudo-feminine breast reduction.
I have been performing transgender surgery (non-genital) for over 2 1/2 decades, and have learned many of these things the "hard way," since I too was a fully-trained and American Board of Surgery-certified general surgeon before I completed plastic surgical fellowship and certification by the American Board of Plastic Surgery, both at the Mayo Clinic. In my 7 years there, I never saw or operated on one identified transgender patient--that came in my first year or two once I started in private practice in 1987.
The surgical results I saw then (and still unfortunately see frequently now) appalled me. Since then I have strived to study the normal male anatomy as a surgical goal, and how to best achieve it surgically for my FTM patients. I see one or two transgender patients each clinic day, and operate on one or two per week, so I have obtained a fair amount of experience from which to derive my observations and comments above. Many transmen will appreciate that these are accurate statements by their own astute observation of my and other surgeons' work.
Let me state with all humility that my work is not "perfect" either, and I have learned "the hard way" how to make my results consistently better. What you see in my own patient results over many years (click on the web reference link below for several examples--a few good, a few less than ideal, and truly a spectrum of my work) is how consistently striving for better outcomes for my transgender patients has influenced my work, and hopefully these words will do the same for a few of my colleagues and patients seeking superior outcomes. They ARE achievable. Best wishes! Dr. Tholen
The 2 major methods are double incision mastectomy with nipple grafting and keyhole.
It depends on the size of your breasts as to which method would be best for you and the ability to maintain nipple sensation
The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
best of luck!
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Yes, I perform breast removal surgery. In some instances female to male chest surgery can be performed with retention of nipple sensation. Other instances a free nipple graft needs to be used. I will be more than happy to assist you to gain an aesthetic identity.